The Problem With Taiwanese Eyes

Amid stagnating wages and a brain drain, deprivation of daylight is ruining the eyes of Taiwan’s children.

By Jens Kastner for The Diplomat

March 12, 2015

When asked why everyone in this neon lamp-lit, windowless classroom wears either thick glasses or contact lenses, the Taipei cram school students are circling in on the usual suspects: the super-fine strokes constituting the Chinese script, TVs, and smartphones are collectively to blame, they say. Not crossing the teenagers’ minds is that the real culprit is their eyes’ dramatic deprivation of daylight; an ad hoc survey reveals that it’s on average less than 30 minutes per day that they spend outdoors in the daylight.

Nearsightedness, or myopia, is a condition in which the eyeball lengthens, so that distant objects become blurry. As Taiwanese children are pushed by state and parents to study inhumanely long hours, 18 percent of first graders, 52 percent of sixth graders and 80 percent of university students on the island were myopic in early 2014, with the Taipei City Government’s Department of Health reporting that the ratio of second-graders with myopia at Taipei’s elementary schools has increased by a whopping 10 percent since. While both disease prevalence and the average degree of the eye’s degeneration are far higher than what is found in the West, the acceleration is also alarming compared to other ethnic Chinese populations in the region. As decades of massive investment flow out of Taiwan, causing domestic wage levels to stagnate and the wealth gap to grow, many Taiwanese families see a white-collar job in mainland China, Hong Kong or Singapore for their children as the ultimate aim of education, and they are effectively prepared to sacrifice good eyesight for it.

“We know that the eyes’ deprivation of daylight is a major factor because of studies comparing the daily routines of ethnic Chinese children in Singapore and Sydney, the latter being a place where myopia is much less of a problem,” says Kung Hsien-lan, deputy director of the Taiwanese government’s Health Promotion Center.

“Taiwanese parents are doing more full-time jobs, and their children spend not only the afternoons and evenings at the cram schools but also the weekends,” she adds.

Ms. Kung furthermore laments that on the rare days when the families do have some time together, “they would often visit indoor playgrounds or stay home because the moms fear getting a suntan, which they perceive as ugly.”

Back in the Taipei cram school classroom, Peter Wang explains that he walks 10 minutes to the public high school in the morning. The 13-year-old suffers from myopia of -5 diopter, which is a grade of severity only 5 percent of populations in non-East Asian advanced countries reach.

In the late afternoon – when all year round it’s already dusk in Taiwan, given its proximity to the equator – Peter would then take a short school bus ride from the high school to the cram school, where he usually stays until 9:30 p.m. Peter does not see much daylight on Saturdays and Sundays, either, as he spends the whole day at two different cram schools.

“Yes, we are supposed to have PE classes outdoors for an hour twice a week, but those are almost always borrowed by the teachers of the more important subjects like Chinese or math,” Peter says.

“I am afraid that the myopia will worsen in the years I still have to go to school, but I must learn more to get into a good university even though I feel the deterioration is speedy.”

Presenting a list of reasons why attending a “good university” to “land a good job overseas” is imperative regardless the frightening repercussions for their eyesight, Peter and his classmates talk of university graduates in Taiwan making only NT$22,000 ($690) per month as starting salaries, while those going to the mainland “get the same amount but in Renminbi,” meaning about five times more. The youngsters also talk of Taipei home prices having become far out of reach for all those who did not make it into a “good university” because they botched their entrance exams.

The notions expressed in the classroom are well supported by economic data.

According local media citing estimations by the Ministry of Labor, Taiwan over the past 10 years has been steadily leaking 27,000 white-collar workers on average a year. According to the Ministry of Interior’s Construction and Planning Agency, an average Taipei income earner would have to work 15.01 years without spending anything to save enough money to buy an average Taipei home, meaning Taiwan has about the highest average housing price-to-income ratio in the world. And behind both figures is another story: Taiwanese investment in mainland China has since the early 1990s accumulated to $144,7 billion, as the once formidable domestic electronics industry, among other sectors, moved most production lines over to the mainland. Despite the current economic slowdown in China, Taiwan’s mainland-bound investments continued to grow by 13.2 percent, to $9.8 billion in 2014, easily outpacing private investment at home, which grew by only half that rate last year. It’s a phenomenon depressing wage levels, which after adjustment for inflation are currently on the same level as in the mid-1990s.

At the same time, the billions of dollars of Taiwanese investments in mainland China have been generating huge returns for Taiwan’s tens of thousands of taishang, the name given to mainland-based expats, so that a lot of undeclared and untraceable money returns to Taiwan, much of it being pumped into the Greater Taipei property market.

“Most parents think their children’s only way for development is to study for a high diploma to get a job and earn enough money to adjust to these times,” says Chiang Chih-cheng, director of the National Taichung University of Education’s Department of Education.

“The greatest pressure is in senior high school, as the parents want their children to pass the exams to enter one of the public universities, which are seen as better than the private ones by prospective employers,” he elaborates.

From Nearsighted Children to Blind Elderly?

Dr. Luke Lin, a retired professor formerly teaching at the National Taiwan University’s College of Ophthalmology, has surveyed myopia in Taiwan since the early 1980s, when he was ordered to do so by the Republic of China military. It was an era when it felt like an invasion attempt by rival communist China could have come at any time, and the poor eyesight of recruits would have had obvious repercussions for their combat readiness.

“The first three island-wide surveys I conducted were not that shocking, but things got bad after the turn of the millennium,” Lin recalls.

“And it is not only the number of sufferers that is alarming but also the increasing prevalence of high myopia, a condition you would seldom find in the West.”

Lin explains that the actual problem is not nearsightedness per se, as the deterioration process slows with adulthood, and poor vision can be corrected with glasses, contact lenses, or laser surgery. Instead, he says, it is that in high myopia cases the eyeball is stretched to an extent that the tissue becomes thinner and fragile, in turn inviting the whole spectrum of eye diseases.

“Most countries do not have well registered courses of severe visual impairment cases, and they just say ‘he has retinal detachment, he has glaucoma,’ and so forth even though the initial problem was high myopia,” he says.

“Although an imperfect diagnosis code makes our data scientifically inconclusive, I am convinced myopia is the most important cause of blindness and visual handicap in many parts of the world.”

Asked about the outlook for Taiwan’s society, Dr. Lin is not optimistic, despite the government’s recent efforts to bring the children out of the classrooms by making more daily outdoor time mandatory at schools. He believes that Taiwanese parents are way too busy at their jobs, working to pay off their high mortgages and the children’s education, leaving their children in the care of Southeast Asian nannies, who will always be tempted to keep the children indoors, silenced with the tablet computer.

“Change will be too slow for Taiwan if the pressure at school and the stringent system of university entry exam examinations persists, and parents and babysitters lack the energy to take the kids outside to see the world,” Dr. Lin says.